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ATTENDING's CONSULTATION WORK IN GENERAL AND ABDOMINAL SURGERY FOR OTHER MEDICAL DISCIPLINES AT AN TERTIARY CENTER OVER 10 YEARS - PROFILE OF CLINICAL FINDINGS, DIAGNOSES AND THERAPEUTIC DECISION-MAKING AS WELL AS THEIR INFLUENCING FACTORS (RESULTS OBTAINED IN A CLINICAL, SYSTEMATIC, PROSPECTIVE UNICENTER OBSERVATIONAL STUDY)
Frank Meyer*1, Manuela Petersen1, Joul Deeb1, Mareike Franz1, Siegfried Kropf2
1Department of General, Abdominal, Vascular and Transplant Surgery, University Hospital, Magdeburg, Germany; 2Institue of Biometry and Medical Informatics, University Hospital, Magdeburg, Germany
Aim: To analyze the spectrum of diagnoses & profile of surgical decision-making as part of surgical attending's consultation work incl. further surgical measures for medical partners and as part of the interdisciplinary cooperation in a representative group of patients at a tertiary center of surgery over a well defined observational time period.
Methods: Over 10 years, all consecutive patients were documented as part of a clinical systematic, prospective unicenter observational study (registration trial DRKS00011888 on DRKS) at a tertiary center using a computer-based patient registry and evaluated with regard to i) patient-, finding- & diagnosis-related spectrum of decision-making (e.g., rate of malignant diagnoses, conformity rate of suspicious and definitive daignosis, rate of operative indication, sex and age difference & others), ii) their significant influencing factors & iii) time-dependent developing trends using χ2 & U tests (p<0.05).
Results (selected corner points):
- From 10/01/2006-09/30/2016, overall 549 cases were documented (sex ratio, m:f=321:228 [1.41:1]; mea nage, 63 [range, 15-98] years).
- Predominating medical discipline in asking for surgical consultation was cardiology (n=109/549; 19.9%) followed by surgical disciplines (n=65/549; 11.8%) & gastroenterology (n=62/549; 11.3%).
- The spectrum of consultation reasons comprised (according to the value in the clinical approach): A) rather clinically oriented: "Additional assessment", 69.8% (n=383/549); "Therapeutic recommendation", 14.4% (n=79/549); "Follow-up", 16% (n=88/549); "Repeated clinical assessment", 2.4% (n=13/549), B) Associated with surgical intervention: Operative indication, 24.4% (n=134/549); postoperative clinical assessment, 6.9% (n=38/549).
- Disturbances of wound healing predominated the diagnostic profile (n=39/549; 7,1%).
- In 13.3% (n=73/549) of patients, indication for immediate (emergency) surgical intervention was derived whereas in 10.6% (n=58/549), elective surgical intervention was recommended.
- Conformity rate of suspoicious and definitive diagnosis was 55.2% (n=187/339).
- Not unexpected, the definitive diagnoses "Hernia" (p=0.049), "Abscess/phlegmon" (p=0.001) and "Cholecystholithiasis" (p=0.009) resulted in the recommendation of an elective surgical intervention while "Acute abdomen" (p=0.000), "Abscess/phlegmon" (p=0.018) and "Cholecystholiasis" (p=0.003) led to an immediate surgical intervention.
Conclusion: The study on the surgical attending's consultation work aims at surgical quality assurance in clinical care of patients with need of additional interdisciplinary, i.e., clinical care in daily practice of general and abdominal surgery as contribution to research on clinical care (and) clinic marketing. Data reflect vividly daily work load of an attending in general and abdominal surgery in a high registration rate of the selected parameters.
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